Provider Demographics
NPI:1043316482
Name:HOSPICE CARE OHIO
Entity Type:Organization
Organization Name:HOSPICE CARE OHIO
Other - Org Name:HOSPICE OF VISITING NURSE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:BAUMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-745-1601
Mailing Address - Street 1:3358 RIDGEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:FAIRLAWN
Mailing Address - State:OH
Mailing Address - Zip Code:44333-3118
Mailing Address - Country:US
Mailing Address - Phone:330-665-1455
Mailing Address - Fax:330-668-4670
Practice Address - Street 1:3358 RIDGEWOOD RD
Practice Address - Street 2:
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-3118
Practice Address - Country:US
Practice Address - Phone:330-665-1455
Practice Address - Fax:330-668-4670
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY HEALTH VENTURES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-15
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH950893251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0122567Medicaid
OH367601Medicare ID - Type UnspecifiedHOME HEALTH HOSPICE